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Selected AbstractsDefinitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagaleHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001Russell W. Hinerman MD Abstract Purpose To evaluate the results of treatment for 71 patients with 80 chemodectomas of the temporal bone, carotid body, or glomus vagale who were treated with radiation therapy (RT) alone (72 tumors in 71 patients) or subtotal resection and RT (8 tumors) at the University of Florida between 1968 and 1998. Methods and Materials Sixty-six lesions were previously untreated, whereas 14 had undergone prior treatment (surgery, 11 lesions; RT, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All three patients who received prior RT had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 66 patients (93%); 5 years, 53 patients (75%); 10 years, 37 patients (52%); 15 years, 29 patients (41%); 20 years, 18 patients (25%); 25 years, 12 patients (17%); and 30 years, 4 patients (6%). Results There were five local recurrences at 2.6 years, 4.6 years, 5.3 years, 8.3 years, and 18.8 years, respectively. Four were in glomus jugulare tumors and one was a carotid body tumor. Two of the four patients with glomus jugulare failures were salvaged, one with stereotactic radiosurgery and one with surgery and postoperative RT at another institution. Two of the five recurrences had been treated previously at other institutions with RT and/or surgery. Treatment for a third recurrence was discontinued, against medical advice, before receiving the prescribed dose. There were, therefore, only 2 failures in 65 previously untreated lesions receiving the prescribed course of RT. The overall crude local control rate for all 80 lesions was 94%, with an ultimate local control rate of 96% after salvage treatment. The incidence of treatment-related complications was low. Conclusions Irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone and neck. There were no severe treatment complications. © 2001 John Wiley & Sons, Inc. Head Neck 23: 363,371, 2001. [source] Ectopic intrathyroidal thymus misdiagnosed as a thyroid nodule: Sonographic appearanceJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2008Stylianos Megremis MD Abstract An 11-year-old boy under suppression therapy for a solitary thyroid nodule was referred for sonographic examination. The diagnosis had been made at another institution, based only on sonography without cytopathologic verification. A small fusiform lesion, which was homogeneously hypoechoic with diffuse bright internal echoes, was demonstrated in the right lower pole of the thyroid. A normal elongated thymus with a cervical component was then found connected to the thyroid with an accessory lobe, which was embedded in the lower thyroid pole mimicking a solitary nodule. We discuss the developmental abnormalities of the thymus and their clinical significance in childhood with a brief review of the literature. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008. [source] Clerking for Justice SouterJOURNAL OF SUPREME COURT HISTORY, Issue 1 2010HEATHER GERKEN Adam Gopnik once observed that "Paris is a struggle between its pompous official culture and its matchless , commonplace civilization." The aphorism applies even more clearly to the Supreme Court. It is an institution cloaked in formality, from the ceremonies of First Monday to the grand generalities it invokes in its ruling. It is also an institution that takes itself extremely seriously, with its strongest opinions penned when it thinks another institution,Congress in passing Commerce Clause legislation or the Religious Freedom Restoration Act, the Florida supreme court during,Bush v. Gore,is treading on the Court's privileges. The Court's pompous officious culture contributes to the studied cynicism lawyers exhibit whenever they talk about judges. [source] Extended Survival by Urgent Liver Retransplantation after Using a First Graft with Metastasis from Initially Unrecognized Donor SarcomaAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2005Jorge A. Ortiz A 58-year-old man underwent orthotopic liver transplantation for polycystic liver disease. Shortly after the procedure, it was discovered that the donor harbored a sarcoma of the aortic arch that had metastasized to the spleen, and bilateral renal cell carcinomas. The two sole organ recipients, our liver recipient and a lung recipient at another institution, were both listed for urgent retransplantation, which they received from the same second donor. The liver explant contained metastatic sarcoma. Twenty-four months survival following lung retransplantation has been previously reported. We report the 76-month disease-free survival in the liver recipient. [source] Paediatric trauma at an adult trauma centreANZ JOURNAL OF SURGERY, Issue 10 2005Andrew J. A. Holland Background: Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC). Methods: A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred. Results: A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks,15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1,75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury. Conclusions: The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC. [source] "Sim Wars": A New Edge to Academic Residency CompetitionsACADEMIC EMERGENCY MEDICINE, Issue 2009Yasuharu Okuda Introduction: Simulation training is an educational modality that is increasingly being utilized by emergency medicine programs to train and assess residents in core competencies. During a recent national conference, patient simulators were used in a competition to highlight multitasking, teamwork, and patient care skills. The combination of audience participation and an expert panel provided a creative forum for learning. Methods: the Foundation for Education and Research in Neurological Emergencies (FERNE) and the Emergency Medicine Residents' Association (EMRA) sponsored an innovative competition between emergency medicine residencies during the 2008 Scientific Assembly of the American College of Emergency Physicians (ACEP). This competition used high-fidelity simulations to create scenarios on neurologic emergencies. Six teams were selected to participate in the three-hour single-elimination competition. The three-member resident teams were then randomly paired against another institution. Three separate 10 minute scenarios were created for the initial round, allowing paired teams to compete on the same scenario. An expert panel provided commentary and insight on the management by each team. In addition, the experts provided feedback in the areas of communication and team training. Each round's winners were determined by the audience using an interactive system. Results: Based on the immediate feedback from participants, audience members and the expert panelists, this event was an entertaining and successful learning experience for both residents and faculty. Like the Clinical Pathological Cases (CPC) competitions, "Sim Wars" provides a showcase for residencies to demonstrate practice philosophies while providing a unique emphasis on teamwork and communication skills. The ability to expand this program to include regional competitions that lead to a national contest could be the framework for future exciting and educational events. [source] Prostate cancer detection in men with an initial diagnosis of atypical small acinar proliferationBJU INTERNATIONAL, Issue 1 2007Pascal A. Mancuso OBJECTIVE To determine the subsequent prostatic adenocarcinoma detection rate amongst men with an initial diagnosis of atypical small acinar proliferation (ASAP). PATIENTS AND METHODS We reviewed the Illawarra Prostate Pathology Database over a 10-year period (January 1994 to January 2004) for specimens diagnosed as ASAP. These specimens were re-reviewed and clinical data obtained. RESULTS Of 61 cases of ASAP, there were complete follow-up data for 31. In this group nine patients had no further biopsies at our institution; the other 22 had at least one repeat biopsy. The incidence of prostatic adenocarcinoma in this group was 17/31 (55%). This included 13 diagnoses on second biopsy, three on third biopsy and one diagnosed at another institution. CONCLUSION This study showed a detection rate for prostatic adenocarcinoma of 55% after an initial diagnosis of ASAP, which indicates that an initial diagnosis of ASAP mandates re-biopsy. [source] | ||||||||||